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Chapter 6: Personal Care Skills

Hygiene: Practices used to keep bodies clan and healthy Grooming: practices to care for oneself, such as caring for ngernails and hair

Assisting with Personal Care:

lowest position & call light within reach

Help the resident be as independant as possible Be aware of resident preferences & routines Always explain what you will be doing Provide Privacy Observe the resident during care Observe mental state of resident Report any changes Leave the residents room clean and tidy. Leave the bed in the

Observe and report the following during Personal Care:

Skin color, temperature, reddened areas Mobility Flexibility Comfort or pain level Strength & ability to perform ADLs Mental & emotional state Complaints

Pressure Points: Areas of the body tha bear much of its weight. Bony Prominences: Areas of the body where the bone lies close to the skin Pressure Sore: A serious wound resulting from skin breakdown; also known as a bed sore or Decubitus Ulcer

Draw sheets: Sheets that are placed under residents to help with turning, lifting, or moving up in bed. Foot drop: a weakness of muscles in the feet and ankles that causes problems with the ability to ex the ankles & walk normally Orthotic Device: A device that helps support & align a limp and improve its functioning and prevent or correct deformities.

Pressure Sore Danger Zones:

There are four stages of pressure Sores.

Stage 1: Area where skin is intact but there is redness that is nots relieved within 15 to 30 minutes after removing pressure Stage 2: Partial skin loss involving the outer and/or inner layer of the skin. the Ulcer is supercial. Stage 3: Full no skin loss involving damage or death of tissue that may extend down to but not through the tissue that covers muscle Stage 4: Full skin loss with major destruction, tissue death, damage to muscle, bone, or supporting structures

Observing the skin:

Pale, white, red, purple areas or blisters and bruising Tingling, warmth, burning Dry or aking skin Itching & scratching Rash or discoloration Swelling Fluid or blood draining Broken Skin Wounds or Ulcers

Remember the following guidelines for skin care:

areas Avoid pulling or tearing skin during transfers In overweight residents pay special attention to skin under folds Follow the care plan and nurses instructions

Report changes in resident skin Provide regular skin care Reposition often, at least every 2 hours Give skin care often for incontinent residents Avoid scratching or irritating skin; report blisters or sores Massage skin frequently, do not massage white, red or purple

The following positioning devices can help make residents more comfortable and safe:

Backrests Bed cradles Draw sheets Footboards Hand rolls Splints Trochanter Rolls Pillows

Remember these guidelines for bathing:

daily Complete baths are only necessary every other day Only use facility-approved products Keep room temperature comfortable Be familiar with safety and assistive devices Make sure water temperature is safe & comfortable Gather supplies beforehand so a resident is never left alone Remove all soap from the skin Keep a record of the bathing schedules

The face, hands, Underarms and perineum should be washed

Perineum: The genital and anal area Pediculosis: An infestation of lice Safety Razor: A type of razor that has a sharp blade with a special safety casing to help prevent cuts Electric Razor: Type of razor that runs on electricity Disposable Razor: Type of razor, usually plastic, that is discarded after use; requires the use of shaving cream or soap

Assisting with Grooming

Residents should do as much for themselves as they can Let residents make as many choices as possible Follow the care plan Be sensitive Never cut toe nails Do not use same nail equipment on more that one resident Report skin breakdown or tears on feet Blisters Long, ragged toenails Ingrown toenails Difference in temperature of feet

Remember these points for combing hair and shaving:

brushing hair. When shaving respect preferences regarding shaving wear gloves Do not share razors between resident Shave in direction of hair growth Discard disposable shaving products properly Do not use electric razors near water, oxygen or pacemakers

Let resident choose their own hairstyles Do not style residents hair in a childing manner Handle hair gently Watch for symptoms of pediculosis while combing or

Assisting with dressing

themselves Place weak arm or leg through garment rst Remove involves side of garment rst when undressing

Follow residents preferences Let residents choose clothing Resident should dress in regular clothes in daytime Residents should do as much as possible for themselves Provide privacy Roll or fold down socks before putting them on Front-Fastening Bras are easier for residents to work by

Remember these guidelines for dressing a resident with an IV:

the pump

Never disconnect IV lines or turn off Always keep the IV bag higher than First remove clothing from the side Check that the IV is dripping

the IV site on the body without the IV line

properly, make sure none of the tubing is dislodged.

Oral Care: Care of the mouth, teeth, and gums Aspiration: The inhalation of food, uid or foreign material into the lungs; can cause Pneumonia or death Dentures: Articial teeth Remember: Oral care may involve brushing the teeth and gums, ossing the teeth with dental oss, and denture care.

Observe and report the following during Oral Care:

Irritation Infection Raised areas Coated tongue Ulcers Flaky, white spots Dry, cracked, bleeding, or chapped lips Loose or decayed teeth Swollen, irritated, bleeding or whitish gums Breath that smells fruity Reports of mouth pain

Observe and report the following during Oral Care for unconscious resident:

be used Use as little liquid as possible to avoid aspiration. squeeze swabs after dipping them in solution to remove excess liquid

Good mouth care keeps the mouth clean and moist Swabs with lemon juice and glycerin or other solutions may

Remember the following when cleaning and storing dentures:

damage them Place them in labeled cup or return them immediately to the resident

Dentures are expensive, handle them carefully Wear gloves when cleaning dentures Report problems with dentures to the nurse Do not use hot water to clean dentures because it may

Fracture Pan: A bedpan that is atter than a regular bedpan Portable Commode: A chair with a toilet seat and a removable container underneath; used for elimination. Remember: It is very important to promote dignity and privacy while assisting residents with toileting.

Positioning: The act of helping people into positions that will be comfortable and healthy for them Supine: Position in which a person lies at on his back Lateral: Position in which a person is lying on either right or left side

Prone: Position in which a person is lying on his stomach

Fowlers: Position in which a person is in a semi-sitting position (45 to 60 degrees) Sims: Position in which a person is in left-side lying position; Lower arm is behind the back & the upper knee is exed and raised toward the chest Logrolling: Method of moving a person as a unit without disturbing the alignment of the body Dangle: To sit up with the feet over the side of the bed to regain balance

Remember the following guidelines for Wheelchairs:

and foot rest Lock before transfer; unlock after Open by tilting chair & pressing down on seat rails. Close by lifting center of seat. Remove arm rest by releasing the arm lock lifting from the center. Remove foot rests by lifting them off when towards side of chair

Know how to use the wheelchair, including brake, arm rest

If residents are frightened or Anxious:

background noise and distraction Describe what your going to do Use simple word and short sentences Check your body language

Keep him calm Speak in a low, calm voice. Use a room with little

If residents shows memory loss: does not understand a word, use a different one Encourage resident to make a list to remember Keep message simple, Break complex task into smaller ones If residents has trouble nding words or names: correct a resident who uses an incorrect word

Repeat yourself using the same words, If a resident

Suggest a word that sounds correct. Try not to

If residents seems not to understand basic instructions or questions:

Ask resident to repeat your words Use short words & sentences, Allow time to answer Use the communication method that are effective Watch for nonverbal cues. Observe body language Use signs, pictures or written words
If residents wants to say something but cannot:

Ask him or her to point, gesture or act it out Offer comfort with a hug or smile if resident is upset

If residents does not remember how to perform basic tasks:

Break each activity into simple steps

If residents insist in doing something the is unsafe or not allowed: instead

Limit the time you say don't

Redirect activities

If residents Hallucinates or is paranoid or accusing: Do not take it personally Try to redirect behavior or ignore it If residents is depressed or lonely: Take time one-on-one to ask how he or she is feeling. Listen to the response. Try to involve the resident in activities. Report depression to the nurse.

If residents is abusive or uses bad language:

Remember it is the dementia speaking & not the person Try to ignore the language. Redirect attention.
If residents has lost most verbal skills: Use non-verbal skills, such as touch, smiles, & laughter Use signd, labels, and gestures Assume people can understand more than they can express

Describe interventions for common problems with ADLs: Urinary Incontinence: Make sure resident is drinking enough uids Note when resident is incontinent, check him or her every 30 minutes Take resident to bathroom before & after meals and before bed Make sure resident urinates before getting off toilet Mark restroom with sigh or picture Be matter-of-fact when cleaning episodes of incontinence. Observe toilet patterns for 2-3 nights if resident is incontinent during night.

Dressing: Show resident what he or she is going to wear Avoid delays or interruptions Give privacy Encourage resident to pick up clothes to wear. Lay out clothes in order to be put on Break tasks down into simple steps. Do not rush the resident Use a friendly, calm voice when speaking Praise & encourage


Schedule bathing when resident is least agitated Give resident supplies before bathing to serve as visual aid. Take walk with resident down the hall & stop at tub or shower room Make sure bathroom is well-lit Keep temperature comfortable Give privacy Be calm and quiet Keep process simple Be sensitive when discussing bathing with resident Give resident washcloth to hold during bath Ensure safety by using nonslip mats, tub seats & hand holds Be encouraging, Offer praise and support Let the resident do as much as possible for him/herself Check skin for signs of irritation

Eating: Have meals at consistent times each day Food should look and smell good Make sure there id good lighting Keep noise and distractions low Remind the residents it is mealtime Keep the task of eating simple, Finger foods are easier to eat. Do not serve steaming or very hot foods or drinks Use dishes without a pattern, Use a simple place setting Give simple, clear instructions on how to eat or use utensils Place spoon on the lips, ask resident to open mouth Guide resident through meal with simple instructions Offer uids to avoid dehydration Use adaptive equipment as needed. Seat residents with others to encourage socializing Observe for eating and swallowing problems Observe and report changes or problems

Additional Tips:

Help with grooming Prevent infections, Follow standard precautions Observe and report potential problems Maintain daily exercise routine Maintain self-esteem. Encourage independence Share in fun activities Reward positive and independent behavior with smiles, hugs,
warm touches, & thank yous

Hallucinations: Illusions a person sees, hears, smells, tastes, or feels Delusions: Persistent false beliefs Perseverating: The repetition of words, phrases, questions, or actions Pillaging: Taking things that belong to someone else Hoarding: Collecting and putting things away in a guarded manner

calm, and soothe

Agitation: Remove the triggers, keep routine, focus on familiar activity, remain Pacing and Wandering: Causes: Restlessness, hunger, disorientation, need for toileting,

constipation, pain, forgetting how or where to sit, need for exercise Remove causes, give snacks, encourage exercise, maintain toileting schedule, let pace in safe place, and suggest another activity

Hallucinations and Delusions: Ignore if harmless, reassure, do not argue, and be calm

Perseveration: questions each time, using the same words Violent Behavior: leave resident alone, remove triggers, and use calming techniques Disruptiveness: about behavior, notice and praise improvements, tell resident about changes, encourage to join in activities, help nd ways to cope, and focus on positive activities

Respond with patience, do not stop behavior, and answer

Block blows, never hit back, step out of reach, call for help, do not

Gain residents attention, be calm, direct to a private area, ask

Inappropriate social behavior: direct to private area, respond positively to appropriate behavior Inappropriate Sexual behavior:

Do not take it personally, stay calm, reassure, nd out cause,

Be mater-of-fact, be sensitive, distract, direct to private area

Pillaging and Hoarding: others that person is stealing, prepare the family, ask family to report strange items, and provide a rummage drawer.

Label belongings, place a label or symbol on door, do not tell

Sundowning: Remove triggers, avoid stress, play soft music, set bedtime routine, plan calming activity, remove caffeine, give back rubs, distract, & daily exercise Catastrophic reactions: tasks, pain, hunger, and distract. Depression: and fear, facing incurable illness, chemical imbalance Report signs, encourage independence, talk about moods & feelings, and encourage social interaction.

Avoiding triggers such as fatigue, changes, overstimulation, difcult

Causes: loss o independence, inability to cope, feeling of failure

Validating: Giving value to or approving Four creative therapies may be used for residents with AD:

Reality orientation Validation therapy Reminiscence therapy Activity therapy